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Medical Forum / Diseases and Disorders / Prostate Cancer / April 2005Lingering Effects of Lupron
This is a follow-up on comments that Alan made and I agreed with regarding the lingering effects of Lupron. I had Pd103 seeds implanted in June 04 and the last 4 mo.Lupron shot in Oct. 04, I just had the first PSA test a week ago that showed <.1, which is great. My Urologist cautioned me that the next PSA might and probably would be higher. I commented that I felt that the Lupron was still doing something, as evidenced by occasional hot flashes and sweats, he confirmed my theory and appeared pleased that I was aware of the process and possibilities. I hope this rings a bell with anyone choosing to cease ADT just because of a good looking PSA assay, the drugs can lower your PSA and shrink the gland, they do not cure the cancer. Tom Tom I took one trial 28-day shot on Feb 11. Now, two months later, I'm still getting the same warm flushes (enough to cost me sleep at night and sweat on a cold day). I'm gonna be one PO'd Jose if these don't go away REAL soon, but the more important message to the collective is that our docs don't know what the heck this stuff will do to any individual patient. They have only large-scale global statistics, which guarantee little, or small-scale personal practice experience, which guarantees much less. My surgical and medical oncologists promised me 1) I'd experience most SEs I'd face (obviously not the long-term stuff like osteoporosis) in that month and 2) be rid of them quickly if I discontinued the shots. Neither occurred, as best as I can tell. I.P. > regarding the lingering effects of Lupron. > I had . . . the last 4 mo.Lupron shot in Oct. 04. > I felt that the Lupron was still doing something, > as evidenced by occasional hot flashes and sweats, [my doc] confirmed my > theory > and appeared pleased that I was aware of the process and possibilities. IP after one 22.5 mg injection of Lupron I switched to Eligard. The result is zero hot flashes for the past year. Can't promise that you would have the same benefit, but it's worth the try. >I took one trial 28-day shot on Feb 11. Now, two months later, I'm still >getting the same warm flushes (enough to cost me sleep at night and sweat [quoted text clipped - 17 lines] >> theory >> and appeared pleased that I was aware of the process and possibilities. I.P. Perhaps I failed to make my point clearly or you failed to understand it. The gist of what I posted earlier is this: A LOW PSA WHILE YOU ARE ON LUPRON OR ZOLADEX DOES NOT INDICATE A CURE (remission, maybe). My statement was directed to those who might be contimplating the cesation of any further treatment based on a low PSA result while they are on ADT. Tom > I took one trial 28-day shot on Feb 11. Now, two months later, I'm still > getting the same warm flushes (enough to cost me sleep at night and sweat on [quoted text clipped - 17 lines] > > theory > > and appeared pleased that I was aware of the process and possibilities. I got both your points, intended or not, but chose to comment only on this one. I.P. > I.P. > Perhaps I failed to make my point clearly or you failed to understand it. [quoted text clipped - 32 lines] >> > theory >> > and appeared pleased that I was aware of the process and possibilities. Ah, "the last of the human freedoms-to choose...." - Frankl >I got both your points, intended or not, but chose to comment only on this >one. [quoted text clipped - 41 lines] >>> > and appeared pleased that I was aware of the process and >>> > possibilities. >I took one trial 28-day shot on Feb 11. Now, two months later, I'm still getting the same >warm flushes (enough to cost me sleep at night and sweat on a cold day). I'm gonna be one [quoted text clipped - 7 lines] > > I.P. I.P. There is an upside as well as a downside to your story. On the one hand, you're still suffering the hot flashes. But on the other, you're probably also still getting the benefit of the Lupron. I'm sure you're right that the doctors don't know how individuals will respond. But don't despair. As I understand it, just about everyone who is on Lupron for a year or less will recover, and most people who are on for several years will also recover, once the drug is stopped. Be patient. Open the window at night. And as we all should do, be happy that we're all still alive. Alan I'm not concened about my lingering effect; I presume it will dissipate before long, and my "hot flashes" hardly warrant the term -- that's why I used the phrase, "warm flushes". They're nothing like the severe variety some people get, and keeping the bedroom at 60 or less and using a fan works pretty well; lost some sleep but no sweaty sheets. My bigger message is to people considering IADT, who really should consider the possibility that some of their effects could linger right through the off-ADT phase until it's shot time again, neutralizing the primary hypothetical benefit of IADT over continuous ADT. It's certainly something I'll research further before I go on ADT some day. I.P. >>I took one trial 28-day shot on Feb 11. Now, two months later, I'm still >>getting the same warm flushes (enough to cost me sleep at night and sweat [quoted text clipped - 28 lines] > > Alan > My bigger message is to people considering IADT, who > really should consider the possibility that some of their [quoted text clipped - 3 lines] > certainly something I'll research further before I go on > ADT some day. My understanding of intermittent ADT is that the patient is given relatively frequent PSA tests in the off period. When the PSA rises above some agreed upon level, he goes back on ADT. So, let's say the level is 10.0 (I'm making that up, I don't know what a good level would be.) The patient gets a 3 month Lupron injection. His PSA stays way down for 6 months. Then it begins to rise. Six months later (or maybe one month later, or 40 months later) it reaches 10 and he gets another injection. This method is independent of how long the effects of the Lupron last. If they last a long time, the "off" period is simply extended. This method makes more sense to me than a straight X months on, Y months off - both for the reasons you point out, and because different patients have more or less aggressive cancers. The patient with a more aggressive cancer needs a shorter time off and the other guy benefits from a longer time off. Alan By the way, a possible benefit of this kind of intermittent ADT for radiation patients is that, if it turned out that the alarming rise a patient experienced was only a "PSA bounce" then, in the first "off" period from ADT, the PSA will probably never rise to the "on" threshold. The guy who didn't opt for IADT would be taking Lupron for the rest of his life, for nothing. I'm wondering if that's what happened to the guy who posted to this group some time ago that he was on Lupron for a year, hated it, and got off to wait for a PSA rise before going back on. Nine years later, he was still waiting! In theory, that could happen to a surgery patient too, if his cancer turned out to be very unaggressive, in which case watchful waiting might have been a better choice for the poor guy than surgery - but that's hindsight. Alan Some IADT protocols call for many months on, a few off, many on, etc., with the off phases barely long enough for some relief from most of its SEs. All the IADT protocols -- even the basic concept -- are still experimental. I.P. "Alan Meyer" <ameyer2@yahoo.com> wrote > > My understanding of intermittent ADT is that the patient is > given relatively frequent PSA tests in the off period. When [quoted text clipped - 20 lines] > > Alan > Some IADT protocols call for many months on, a few off, many on, etc., > with the off phases barely long enough for some relief from most of its > SEs. All the IADT protocols -- even the basic concept -- are still > experimental. Well, nevertheless and notwithstanding, an article entitled "Intermittent Androgen Deprivation in Prostate Cancer Patients: Factors Predictive of Prolonged Time Off Therapy" was published in The Oncologist, Vol. 5, No. 1, 45-52, February 2000. The authors are Stephen b. Strum, Mark C. Scholz, and Jonathan E. McDermed, then of the Prostate Cancer Research Institute. Here are their "Results. In the first IAD cycle, the median duration of the on-phase of IAD was 16 months (mean 19.0 months, range 3.6-71 months), and the median off-phase duration was 15.5 months (mean 24.1 months, range 3.2-87+ months). In 28 patients who maintained a UD-PSA for 1 year, their median off-phase duration was 29 months (mean 35.8 months, range 7.8-87+ months), with nine (32%) still off IAD after a median follow-up of 62 months. Significant (p < 0.05) independent factors associated with prolonged off-phase duration by multivariate analysis included UD-PSA on ADT 1 year (p = 0.010), PSA-only recurrence after local therapy (p = 0.039), and reaching a testosterone level 150 ng/dl in 4 months off ADT (p = 0.041). After a median of 66 months of follow-up, only one (2%) patient developed androgen-independent PC. Conclusions. Hormone-naïve patients who achieve and maintain a UD-PSA for at least one year during ADT may initiate IAD and anticipate a prolonged off-phase duration. Attainment of a UD-PSA on ADT may serve as an in vivo sensitivity test of a patient's tumor cell population, and allow for better selection of those best suited for IAD." Does IP have later, contrary, info? Regards, Steve J "Always do right. This will gratify some people & astonish the rest." -- Mark Twain, "Advice to Youth" > Well, nevertheless and notwithstanding, an article entitled "Intermittent > Androgen Deprivation in Prostate Cancer Patients: Factors Predictive of [quoted text clipped - 6 lines] > "Results. . . . > > Conclusions. . . . > Does IP have later, contrary, info? Newer? Don't recall. Contrary? Not so much contrary as just much more, covering more ground. This reference was one of probably more than 30 ADT analyses I drew from. My abbreviated, symbol-laden, bottom-line-conclusions-only, highlights for busy oncologists filled a page or two. I.P. |
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